Lesson Plan Spring 14

Unit Objective

HolubLesson Plan

NUR 4334 Nursing Care of the Childbearing Family

Spring 2014

HolubLesson Plan

NUR 4334 Nursing Care of the Childbearing Family

Spring 2014

dateUnit ObjectiveContentLearning ActivityReadings refer to Lowdermilk, 10th ed. Unless otherwise stated.

1/13Prerequisites: These objectives reflect knowledge that you should have obtained in your Anatomy and Physiology class as a prerequisite to nursing school and/or in Patho-Pharm II and Human Needs II. If you did not learn this info, you should spend some time learning it. This information forms the foundation of all of childbearing. You Will be tested on this information in this class directly and indirectly! The Learning activities column identifies areas of the Lowdermilk text that cover this information. There is also information in your Patho-Pharm and Human Need texts. I will provide a VERY brief review during class day 1. However, you are responsible for knowing this information, even if I do not cover it in class. If you need more assistance, please schedule an appointment with your faculty.

Identify the physiologic processes involved in the menstrual cycle .Identify family planning options, advantages and disadvantages of each, and apply the nursing process to facilitate need fulfillment.

Discuss nursing assessment of woman related to family planning options

List common causes of infertility.

Describe common diagnoses and treatments for infertility

Differentiate signs and symptoms of common menstrual disorders.

Describe the etiology, clinical manifestations, and nursing and collaborative management of menstrual problems and abnormal vaginal bleeding.

Apply the nursing process to facilitate need fulfillment for the woman with menstrual disordersDescribe the prevention of sexually transmitted infections in women.

Provide basic intra operative and postoperative nursing care to a surgical patient.I. Female reproductive systemII. Menstrual Cyclea. Phases

i. Menstrual

ii. Proliferation (follicular)

iii. Secretory

iv. Ischemic

b. Length

III. Menstruation/puberty & Menopause/climactericIV. Contraception & infertilityV. Menstrual Disorders

a. Amenorrhea

b. Dysmenorrhea

c. Premenstrual syndrome (PMS)

d. Endometriosis

e. Alterations in cyclic bleeding

VI. Health Promotion and STI prevention

VII. Perioperative nursingVerify your comprehensive understanding of the reproductive systems and the menstrual cycle. (Lowdermilk pp: 67-69; Lewis, Ch 51 53) Text: Ch. 4

Scan & review pp 61-65; read & study pp 67-69;

STUDY/MEMORIZE/UNDERSTAND fig. 4-7, p 68.

Contraceptives:

Lowdermilk Ch. 8 + patho pharm

read pp 169-189; Study Box 8-1, p 171; Teaching for Self-management, p173, 178-179,180, 187, Figure 8-8 p 183, signs of potential complications, p. 183; & 186 and the Nursing Alert boxes.

Induced Abortion pp 189-192. Study Safety alert box, p 191.

Infertility Ch. 9 scan pp. 194-209

Read:

Box 9-1 Factors Affecting Female Fertility

Box 9-2 Factors Affecting Male Fertility

Box 9-3 Religious and Cultural Considerations of Fertility

Box 9-5 Summary of Findings Favorable to Fertility

Table 9-2 Nursing Actionsimpaired fertility

Medication Guide: Infertility Medication p. 205

Box 9-7 Issues.before treatment p. 206

Table 9-3 Assisted Reproductive TherapiesMenstrual disorders: Lowdermilk Ch. 6

Scan pp 119- 141. Read Decision to Use Hormone Therapy, p. 134.

Health Promotion: Read Anticipatory guidance for health promotion . . . pp 88 -93; Table 4-3, p 89

Key Points, p. 93STI

Ch. 7: Scan/ Review pp 143-167; Focus on symptoms, treatment & pt. teaching for each diseasePerioperative: scan/reviewLewis, 8th ed (Medical-Surgical Nursing Text):

Ch. 18, 19, 20

preIdentify the competencies outlined in the Essential Competencies in Genetics and Genomics for all Nurses. Compare and contrast predictive, presymptomatic and predispositional testing.

Differentiate genotype and phenotype.Identify normal chromosome counts in the human.

Define trisomy

Differentiate the inheritance pattern of dominant, recessive and sex linked conditions.

Define karyotypeVIII. Geneticsa. Essential Competencies

b. Gene identification and testing

c. Genotype, phenotype and karotype

d. Autosomal abnormalitiese. Patterns of transmission

Genetics: Lowdermilk: Chapters 3Read essential Competencies . . . p 44; Gene identification and Testing, p. 45; Factors influencing the decision . . . p 47. ; Review/Scan p 47-51; Read pp 52-57.

UNIT I ANTEPARTUM

1/13Evaluate contemporary issues and trends in maternity nursing.

Relate the role of culture in caring for childbearing families.

I. Course Intro/AP

A. Contemporary Issues and Trends

B. Cultural Aspects of Care

C. Health Risks in the Childbearing years

Lowdermilk:

Ch1: Read:

P. 3, Boxes 1-2 & 1-3; p 4, box 1-4; p.5, box 1-6 Childbirth Practices pp 7-8; Sentinel Events, pp 12-13 Ch. 2 : Read:

Family in Cultural and Community Context pp 18-19

Box 2-2 p 25; Table 2-2, pp. 26-27: Traditional Cultural Beliefs; Childbearing and Parenting

p. 27 culture considerations boxCh. 4: Read: pp. 73-78 (Health risks in the childbearing years)

1/27Discuss the impact of pregnancy on family members

Summarize psychosocial and behavioral changes that usually occur as the mother and other family members adapt to pregnancy.Identify components of a preconception visit and the significance of each.

Conduct a complete history for a pre-conception visit.

Provide health promotion education for a preconception visit.

Summarize the process of fertilization

Examine the development, structure, and functions of the placenta.

Explain fetal circulation.Summarize the significant changes in growth and development of the embryo and fetus.

Recognize major milestones of embryonic and fetal development and provide appropriate patient education.

Differentiate the major organs or tissues arising from each of the three primary germ layers.

Define teratogen.

Explain the principles of teratology.

List known and strongly suspected human teratogens.

Explain the effects of major teratogens.

Rank, in order of frequency, the major causes of congenital malformations.

Identify the periods of embryonic/fetal vulnerability for teratogens and the different effects.Develop an individualized teaching plan based on a womans actual and risk for exposure to specific teratogensD. Psychosocial Aspects in nursing care of the childbearing family

1. Role Changes2. AttachmentII. Preconception Care, Fertilization/ Embryology/Genetics

A. Indicators of ovulation

B. Conditions for fertilizationC. Preconception Care

III. Antepartum

A. Implantation

B. Fetal Development

1. Embryonic and placental development

a. Critical periods

2. Germ cell differentiation

3. Teratogens

a. Principles of teratology

Chapter 15. Read pp. 330-336

Read:

Preconception care: Ch. 4 p. 70-72

Box 4-1 Components of Preconception Care

Box 4-2 Major Goals of Prenatal Care

Box 4-3 Contraceptive Health Promotion

Read carefully: Conception and Fetal development Ch. 12 pp.270-288

Study: Figs 12-6, 12-7, p. 275; Fig. 12-10, p. 277 Table 12-1, pp. 284-286, Milestones in Human Development before birth, since last menstrual period Figure 12-8, p. 276 Sensitive or Critical periods in Human development Figure 35-11p. 856, Critical periods in human embryogenesis

Supplemental reading: Handouts on Blackboard:

Preconception care

Psychosocial Adaptations to Pregnancy

Fetal Growth and Development

Genetics in Nursing

1/27Compare and contrast pregnancy tests (home and laboratory).

Differentiate among presumptive, probable and positive signs of pregnancy.

Use Naegles Rule to determine the expected date of birth.

Identify criteria used to determine gestational age.

Identify fetal measurements used to date a pregnancy by ultrasound during each of the trimesters of pregnancy.

Discuss the maternal hormones produced during pregnancy, their target organs, and their major effects on pregnancy

Document a womans obstetric history using the GTPAL system and the G/P systems.

Explain the expected maternal anatomic and physiologic adaptations to pregnancy.

Compare and contrast common lab values for the healthy adult and the healthy pregnant woman.

A. Anatomy and physiology of pregnancy

1. Gravida, para, terminology, GTPAL2. Pregnancy tests

3. Physiologic adaptations

4. Lab values

5. Diagnosis of Pregnancy

6. EDB; estimation of gestational age (Naegels rule, Ultrasound, fundal height, quickening)

A&P: Read:

Ch.13: pp. 288-305; Ch.15 pp.329-330 I(to adaptation to pregnancy

pp. 341-343 (paragraph headings Fetal Assessment to Health Status); Gestational Age Assessment: p. 641 (Gestational age paragraph)

Study: Table 13-2 Signs of Pregnancy p.292;

Fig 13-3, Height of fundus p. 293; Table 13-3 Laboratory Values for Pregnant and Nonpregnant Women p. 299 (memorize normal Hgb & Hct in preg)

Supplemental Reading, Handouts on Blackboard:

Diagnosis of Pregnancy

Exercise/Quiz I

Gravida and Para Exercise on Blackboard. This is a blackboard on line quiz. You will have one hour to complete the 8 questions. Each question has 2 correct answers. You can go forward and backward in the quiz, but you only have 1 hour. Please have your Lowdermilk text and review p. 290 before you open this exercise.

2/3Explain the importance of nutrition during the childbearing years.

Identify nutritional risk factors during pregnancy.

Provide nutritional counseling to a woman prior to conception.

Examine guidelines for weight gain in pregnancy.

Identify dietary recommendations for energy sources, protein, and key vitamins and minerals during pregnancy and lactation.

Give examples of food sources which provide the nutrients required for optimal maternal nutrition during pregnancy and lactation.

Assess nutritional status in pregnancy.

Develop a nursing plan of care for a pregnant woman with pica.

Appropriately refer pregnant women to dietician for nutritional counseling.

Compare the dietary needs of pregnant adolescents and mature pregnant women.

Provide health promotion education for nutrition in pregnancy.

B. Nutrition

1. Nutrient needs during Pregnancy

a. Weight gain

b. Protein

c. Fluid

d. Vitamins and Minerals2. Pica and cravings

3. Adolescent nutritional needs4.Nutrition during lactation

Chapter 14 Read pp. 307-328 Read Box 14-1 Food Sources of Folate p. 309

Study

Fig 14-2, p 309 Table 14-1 pp 310-311; recommendations

box 14-2, p 311 Wt gain

Table 14-3 p 313; Daily food guide

Box 14-5, p 315; Indicators

box 14-6 , p 317 Ca sources . . .

Teaching for Self-management: Fe supp p. 325

box 14-8, p 326, suggestions

Scan table 14-6, pp 326-327 Popular foods

2/3Outline the patterns of health care used to assess maternal and fetal health status at the initial and follow up visits during pregnancy.

Identify the purpose of prenatal care.

Review the history of prenatal education.

Explain the theoretical basis for childbirth education.

Explain the goals of perinatal education

Compare and contrast prenatal education programs,

including Lamaze, Dick-Read, Bradley Method.

Compare and contrast the different choices of care providers for obstetric care in the U.S.

Explain the role and benefits of a doula.

Apply the nursing concept of anticipatory guidance to prenatal preparation and education.

Evaluate assessment findings of the antepartum woman.Evaluate risk factors in pregnancy.

Discuss common discomforts of pregnancy, etiology and nursing assessment and interventions.

Provide patient/family teaching regarding the common discomforts of pregnancy and signs and symptoms of potential complications.

Develop a nursing plan of care for an uncomplicated pregnant woman.

Examine the impact of culture, age, parity, and number of fetuses on the response of the family to the pregnancy and on the prenatal care provided.

Provide pt. /family teaching regarding lifestyle choices in pregnancy (exercise, nutrition, substance abuse, stress management, etc.)Identify/counsel a pregnant woman regarding immunization needs before, during and after pregnancy

C. Nursing Care during Pregnancy

1. Prenatal Care

a. Purpose

b. Barriers

c. Patterns

D. Prenatal educationE. Assessments

1. Initial

2. Followup

3. Lab values

4. Signs of potential complications

5. Risk assessment

a. Expected Outcomes

b. Plans, Interventions and evaluations

i. Health Promotion and self management for discomforts of pregnancy

ii. Recognition and follow up of potential complications

iii. Psychosocial support

c. Variations in Prenatal Care

Nursing Care

Ch 13, Read: Pp 289-291 STUDY terminology & definitions.

Read Box 13-1,p 297, BP measurement

Read pp 336-367 Study:

Terminology & definitions, pp 2890290

Table 13-1, p 290 Obstetric history . . .Watch Evolve Video Series: Jarvis Head to toe exam of the pregnant women (on LRC site)Ch 15 Read pp 329-330; 336-367 table 15-1 Lab tests in prenatal period: p 340

Box 15-4, HIV screening. p 340 Read Teaching for self-management:

Exercise Tips; p 347

Posture and Body; p 348,

Safety During Pregnancy p 349, Sexuality p 353,

Read Box 15-5, p 349, Conscious relaxation

p 356-357, Nursing Care Plan

Study: Box 15-3, p 336, Prenatal visit schedule

emergency box, p 341, Supine hypotension

STUDY HARD; practically memorize Signs of potential complications p. 342.

STUDY HARD: Table 15-2, pp 354-355, Discomforts

Ch. 26

Read

Pp. 637-649 Categories of High . . ., box 26-1, p.638

Specific pregnancy Problems and Related Risk Factors, box 26-2 p. 639

2/10Differentiate among diagnostic techniques for assessment of fetal well being, including when they are used in pregnancy and for what purposes.

Evaluate the procedures and results of tests of fetal well being:

MSAFP/triple screen

BPP

NST

CST

Amniocentesis

Chorionic villi samplingDevelop a teaching plan to explain procedural techniques and implications of findings for MSAFP, Triple Screen, amniocentesis, chorionic villi sampling and percutaneous umbilical cord blood sampling to a pregnant woman and her family.

Compare and contrast procedures for genetic testing.

Explain the reliability of the findings of diagnostic testing for fetal well being.

Interpret the results of diagnostic techniques for assessment of fetal wellbeing.

Explain the basis for fetal heart rate monitoring in labor.

Identify the advantages, disadvantages and contraindications (if applicable) of different modes of uterine activity and fetal heart rate monitoring in labor (ua intermittent palpation, tocotransducer, IUPC; FHR intermittent auscultation, ultrasound transducer, fetal scalp electrode).

Given an electronic fetal monitor tracing, determine:

Frequency, duration, intensity of contractions and resting tone of the uterus.

FHR baseline, variability, patterns.

Use NICHD guidelines to identify electronic FHR patterns.

Describe the physiologic basis and nursing implications electronic FHR patterns seen in labor.

Prioritize nursing interventions for each of the following fetal heart rate patterns.

Fetal tachycardia

Fetal bradycardia

Early decelerations

Variable decelerations

Late decelerations

Prolonged decelerations

Minimal to absent fetal heart rate variability

Distinguish reassuring and nonreassuring electronic fetal heart rate patterns in labor.

Trouble shoot common problems with electronic fetal heart rate and uterine activity monitoring.F. Assessment of Fetal Wellbeing

a. Daily Fetal Movement Counts

b. Ultrasound

i. Doppler Flood Flow

ii. Amniotic Fluid Volume/Amniotic Fluid Index

iii. Biophysical Profile

iv. Amniocentesis

v. Chorionic Villi Sampling

c. Fetal Heart Rate Monitoring

i. Physiology of Fetal Heart Rate Monitoring

a. NST, CST

Ch. 18

Read

pp. 415-431

Box 18-2, p. 418 procedure for intermittent. . .

Nursing alert, p. 418 Clinical reasoning exercise, p. 424

Nursing alert, p. 425

Box 18-7, p. 427, Checklist . . .

Legal tip, p. 428

Box 18-8 p. 428 Management of abnormal. . .

Box 18-9, p 430, Client and family. . .

Box 18-10, p 431 Checklist. . .

Study

Box 18-1, p. 416 Three-tier. . .

Table 18-1, p.416 Normal uterine . . .

Table 18-2, p 419 External and. . .

Figs 18-2, 18-3 & 18-4 p. 420

Fig. 18-5, p. 421

Table 18-3, p. 422

Fig. 18-9 & Box 18-3 p. 423

Fig. 18-10 & Box 18-4 p. 424

Fig. 18-11 & Box 18-5 p. 425

Fig. 18-12 & Box 18-6 p. 426

Fig. 18-13 p 426

Nursing Process, Electronic Fetal . . . p. 427 Table 18-4, p. 429 Approximate normal values. . .Ch 19

Read

Pp 443-445 (Assessment of uterine contractions section)

Nursing alert boxes (2 of them), p. 445

Chapter 26: Read

pp. 639-652 (start at antepartum testing) Box 26-1 Specific Pregnancy Problems and related Risk Factors p. 639

Box 26-3 Common Indications for Antepartum Testing p. 639

Nursing Alert, p. 640

Table 26-1 Major Uses for US during Pregnancy p. 641

Clinical reasoning exercise, p 645


Table 26-4 Summary of Biochemical Monitoring Techniques p. 646

Box 26-6 Indications for EFM p. 649

Study

Table 26-2 Biophysical Profile Scoring p. 643

Table 26-3 Biophysical Profile Mgmt. p. 644

Figs. 26-10 & 26-11 p. 650

Box 26-7 Interpretation of NST p. 651

Fig. 26-12, p. 651


Figs 26-13 A & B, p 652

Box 26-8 Interpretation of CST p. 652

Handout on Blackboard:

JOGNN NICHD Terminology

Supplemental Reading, Handouts on Blackboard:

Testing for Fetal Well-Being

Fetal Heart Rate Tracing Interpretation

NCC Applying NICHD terminology

EFM Practice strips and answers

Exercise/Quiz 2: Blackboard quiz on fetal assessment

UNIT II: INTRAPARTUM

2/10List the signs of labor.

Explain the factors that affect the labor process.

Describe the anatomic structure of the head of the term fetus.

Explain the significance of the size and position of the fetal head during labor and birth.

Given a diagram, identify:

Fetal lie

Fetal presentation

Fetal presenting part

Fetal position

Most likely location to auscultate FHR

Describe the anatomic structure of the bony pelvis.

Describe the various pelvic types and the implications for labor and delivery.

Examine the physiologic risks of labor in adolescents.

Summarize the cardinal movements of the mechanism of labor for a vertex presentation.

Identify the stages and phases of labor.

Explain the phases of second stage labor.

Explain the maternal and fetal adaptations to labor.II. Intrapartum

A. Labor

1. Diagnosis / Definition2. Factor affecting labor 5 Ps

a. Passenger

(size of head, presentation, lie, attitude, position)

b. Passageway

(bony pelvis, soft tissue)

c. Powers

(primary, secondary)

d. Position

e. Psyche3. Process of labora. Onset

b. Stages and phases

c. Mechanisms (7 cardinal movements)4. Maternal and fetal adaptations to labor

Ch. 16 Read

pp 369 384 Fig 16-5 A,B,C

Fig 16-12 Clinical reasoning, p. 380

Study Fig 16-3 A,B,C,D p. 372

Fig 16-4 p. 372

Fig 16-7 p. 373

Fig 16-8, p. 374

Table 16-2 p 376 Fig 16-10 A, p 376

Fig 16-11 A,B,C,D p. 377

Fig 16-13 A-F, p 381

Box 16-2, p 383, Maternal physiologic

Memorize Fig 16-1 A&B, p. 370 Fig 16-2, p 371

Fig 16-6, p 373

Box 16-1 p 380 Signs preceding. . .

Supplemental Reading: Handout on Blackboard:

Intrapartum Overview

2/17Discuss the causes of pain in childbirth.

Outline adverse effects of pain on maternal and fetal well-being.

Explain the behavioral cues and verbal indicators of pain in the woman during labor and birth.

Explain the theoretical basis of nonpharmacologic pain relief methods.

Demonstrate breathing and relaxation techniques used for each stage of labor.

Differentiate between active relaxation, passive relaxation, distraction and patterned breathing techniques used in childbirth.

Use appropriate nonpharmacologic strategies to enhance relaxation and decrease discomfort during labor:

Hydrotherapy

Breathing & relaxation techniques

Massage / Effleurage

Environmental control

Positioning

Pressure and counter pressure

Encouragement and support

Differentiate analgesia and anesthesia.

Identify the most common types of obstetric analgesia and anesthesia.

Analyze pharmaceuticals (systemic analgesics and regional anesthetics) used to relieve labor pain, including drug classification, route(s) of administration, therapeutic effects, side effects and contraindications.

Describe nursing responsibilities during and immediately after the administration of obstetric analgesia or anesthesia.

Prioritize nursing interventions for complications of regional anesthetics.

Discuss the use of naloxone (Narcan).

Compare and contrast general anesthesia, local anesthesia and regional anesthesia.

Explain the indications for and nursing care of a patient receiving an antilogous epidural blood patch.

Develop a nursing plan of care for a laboring woman with an epidural anesthetic.

Develop a nursing plan of care for a post Cesarean birth patient with epidural/intrathecal medications and for a post Cesarean birth patient with patient controlled analgesia.

B. Labor Pain

1. Etiologies

2. Effects of pain

3. Nonpharmacologic pain relief

4. Pharmacologic pain relief

a. Analgesia and sedatives

b. AnesthesiaCh. 17 Read

pp. 386- 413

Cultural considerations, p. 388

Box 17-1, p. 389 Suggested Measures

Evidence-based practice, p. 390

Clinical reasoning, p. 391

Box 17-2 p 391, Nonpharamocologic

Nursing alert, p. 398 Signs of potential complications, p. 400

Safety alert, p. 401

Fig. 17-11 A,B,C, p. 403 Fig. 17-12, p. 404


Legal tip, p. 408

Nursing Process, p. 409

Nursing care plan, p. 410

Box 17-6, p. 411, Nursing interventions



Study

Box 17-4, p 398, Pharmacologic Medication Guides (2 of them), p. 399


Medication guide, p. 400

Fig. 17-8 A&B, p. 401

Fig. 17-10A&B, p. 402

Emergency Box, p. 403

Box 17-5, p. 405 Side effects. . .

Memorize

Box 17-3, p 393, Paced breathing

DVDs: View these them independently in the LRC. Material on videos may be tested.

DVD on reserve in LRC:

Choices I Childbirth, Vol. 1, Epidural Anesthesia WO 450 C545 2000

(20 min.)Supplemental Reading: Handout on Blackboard:

Pain in Childbirth

2/17Assess the intrapartum family to fulfill human needs.

Distinguish true and false labor.

Use Leopolds Maneuvers to identify:

Fetal lie

Fetal presentation

Fetal presenting part

Fetal position

Most likely location to auscultate FHR

Outline the standard of nursing care for assessment of the woman and fetus in each stage of labor.

Identify factors that increase a laboring womans risks for complications during labor and birth. Relate identified risk factors to specific complications.

Prioritize the factors included in the initial assessment of the woman in labor.

Based on a womans physical and psychosocial responses, evaluate the need for a vaginal exam to assess the progress of labor.

Interpret the results of a cervical exam of a laboring woman.

Evaluate the progress of labor.

Evaluate the laboring womans behavioral adaptations to the phases and stages of labor.

Assess uterine activity using palpation, tocotransducer and IUPC (adequate?)

Evaluate the fetal response to labor.

Identify the nurses role in promoting the progress of labor.

Prioritize nursing interventions for a woman in each phase of first stage labor.Describe the role of activity and positioning in the progress of first stage labor.

Select appropriate positions for the laboring woman based on assessment data.Appropriately respond to increased risks and signs of developing complications during labor and birth.

Discuss the nurses role in management of pain for the laboring woman.

Describe the pathophysiology and nursing interventions for hyperventilation in labor.

Provide and evaluate the effectiveness of patient teaching regarding analgesia and anesthesia in labor.

Describe symptoms of and nursing interventions for a woman laboring with a fetus in the OP position.

Coach and support the laboring woman and her partner throughout labor and birth.

Provide patient and family teaching throughout the labor and birth process.

Prioritize nursing care for a woman during and immediately after spontaneous or artificial rupture of the amniotic membranes.

Develop a nursing change of shift report for a woman in labor.

Develop a safe & comprehensive plan of care for women experiencing:

Spontaneous labor with and without Epidural anesthesia.C. Nursing Care of the woman and family in labor

1. Stage I

a. Assessments (admission & ongoing)

i. Maternal; Assessment of contractions

ii. Fetal Well Being in labor

iii. Psychosocial, cultural and family Responsesb. Interventions - Positioning, foleys, oxygen, IVs, coaching

c. Pain Management

DVDs: View independently in the LRC. Material on videos may be tested.

High-Touch Nursing Care During Labor

Admission Assessment(AWHONN, 2006)

WQ39H638, V-1 (37 min)Ch. 19 Read

pp. 433-472 How to Distinguish True Labor from False Labor Box p. 434

Procedure: Tests for Rupture of Membranes p. 437

Box 19-2 p. 439, Psychosocial assessment Cultural Considerations Box p. 440

Nursing Process: First Stage of labor pp. 441-442

Procedure: Leopold Maneuvers p. 443

Fig 19-5: Supine Hypotension p. 444

Fig 19-7: Assessment of Uterine Contractions p. 446

Fig 19-8: Labor curves (partograms) p. 447

Box 19-4 EBP to promote, protect and support normal labor and birth p. 448

Nursing Care Plan: Labor p. 449

Table 19-2: Physical Nursing Care During Labor p. 450



EBP box, p. 454

Clinical reasoning, p. 455

Box 19-6: Guidelines for Supporting the Father p. 457

Study

Table 19-1, Expected Maternal Progress in First Stage of Labor p. 439

Fig 19-6:Location of FHTs p. 445


Signs of Potential Complications: Labor p. 448

Box 19-5, p. 455 Common maternal

Emergency Box: Interventions for Emergencies During Labor p. 459

DVDs:High-Touch Nursing Care During Labor

First Stage Labor Support (AWHONN, 2006)

WQ39H638, V-2 (40min)Supplemental Reading: Handout on Blackboard:

Labor Support

2/17Identify physical and nonverbal signs of second stage of labor for nursing assessment.

Explain the phases of second stage labor.

Identify normal parameters of second stage of labor.

Compare and contrast various pushing techniques for second stage labor.

Provide labor support for second stage labor, including teaching and supporting the womans significant other.2. Stage II

a. Assessments

i. Maternal

ii. Fetal

b. Interventions

c. Pushing Techniques

d. Positioning

High-Touch Nursing Care During Labor

Second Stage Labor Support

AWHONN, 2006

WQ39H638, V-3 (36 min)Ch 19

Read Pp 457 472 as above

Nursing Process: Second Stage of Labor p. 461

Box 19-7 Guidelines for Assistance at the Emergency Birth of a Fetus in the Vertex Presentation p. 462

Fig. 19-16 A-E, p. 463

Box 19-8, pp 468-469 Normal vaginal birth

Fig 19-23 p 471

Study

Table 19-3 Expected Maternal Progress in the Second Stage of Labor p. 460

2/17Identify the nursing role in third stage of labor.

Recognize complications in the third stage of labor and provide appropriate nursing interventions.

Explain the indications for use, therapeutic effects, side effects, contraindications and nursing implications of medications administered in third and fourth stages of labor.

3. Stage III

a. Assessments

b. InterventionsCh. 19 Read

pp. 471-472 as above Nursing Process: Third Stage of Labor p. 472

Fig 19-24 Third Stage of Labor p. 473

Fig 19-25, p 473Supplemental Reading: Handout on Blackboard:

Inspection of the placenta

2/17Define labor dystocia; explain 5 causes.

Differentiate hyper and hypo uterine dysfunction in labor and their management.

Explain:

Precipitous labor

Protracted active phase of labor

Secondary arrest of labor

Prolonged latent phase of labor

Differentiate fetal malposition and malpresentation.

Provide pt/family teaching and coaching for fetal malposition.

Describe management for fetal malpresentation

Distinguish between induction and augmentation of labor and identify the common modes of each.

Describe nursing responsibilities before and after amniotomy.

Describe major precautions to be considered when infusing xytocin for induction of labor.

Analyze pharmaceuticals used for labor induction and augmentation, including drug classification, route(s) of administration, therapeutic effects, side effects and contraindications.

Summarize nursing care management for forceps and vacuum-assisted birth.

Develop a safe & comprehensive plan of care

for women experiencing labor induction and/or augmentation.

Evaluate the effectiveness of and patient responses to labor induction / augmentation.

Provide nursing care for a woman with labor induction / augmentation.

Identify uterine hyperstimulation in labor. Explain how it affects the fetus.

Prioritize nursing response to uterine hyperstimulation during induction or augmentation of labor.

Provide nursing care for the intrapartum family undergoing scheduled and emergent Cesarean Births.

Identify criteria for VBAC.

Explain risks and benefits of vaginal birth after cesarean (VBAC).

Develop a nursing plan of care for a woman undergoing a Cesarean birth.

Identify risks of cesarean births.

Examine advantages and disadvantages for regional and general anesthesia for cesarean birth.4. Alterations in labor patterns and mode of birtha. Labor alterations

b. Induction and augmentation

c. Operative vaginal birth

d. Cesarean Birthse. VBACCh 33 Scan

Figs 33-9 p. 806 & 33-10 A&B, p. 807

Box 33-10 Selected measures p. 808

Read

Pp 792 (Dysfunctional labor) 815 (stop at Postterm)

Box 33-7: Measures to Reduce Back p. 795

Figure 33-3 Breech Presentation p. 795

Figure 33-4 A-G Mechanism of Labor p. 796

Legal tip, p. 797 Nursing Process: Dysfunctional Labor p. 798

Fig 33-6 External Version p. 799

Box 33-8 Indications & Contraindications for Labor Induction p. 800

Procedure: Assisting with Amniotomy p. 803 Safety Alert, p. 803

Table 33-4 Definitions for Forceps and Vacuum-Assisted Births p. 806

Box 33-9: Assisting with Birth p. 807

Box 33-11 Indications p. 809

Clinical Reasoning, p. 809

Figs 33-11 & 33-12: Cesarean Birth; skin and uterine incisions p. 810

Legal tip, p. 812

Teaching for Self-Care: Postpartum Pain Relief After Cesarean Birth p.813 and Signs of Postoperative Complications after discharge p. 814

Safety alerts (2 of them), p 814

Box 33-12 Selection Criteria for VBAC p. 815

Study

Table 33-1: Dysfunctional Labor: Primary and Secondary Powers p. 793

Table 33-2: Abnormal Labor Patterns p. 793

Table 33-3: Bishop score p. 800

Medication Guidelines: p. 801 Prostaglandin E1; Misoprostol; p. 802 Prostaglandin E2: Cervidil, Prepidil; p. 804 Oxytocin(Pitocin)

Nursing alert, p. 803 Legal tip, p. 803

Emergency Box: Uterine Tachysystole with Oxytocin, p. 805

DVD: Choices in Childbirth, Vol. 2, Induction and Augmentation. WQ 440 C545 2000 (17 min)

2/24EXAM I

UNIT III: THE POSTPARTUM FAMILY

2/24

Explain the nurses role in fourth stage of labor.

Identify factors that increase a laboring womans risks for complications during recovery. Relate identified risk factors to specific complications and prioritize nursing interventions.

Prioritize nursing assessments in fourth stage for vaginal and operative delivery.

Provide family centered nursing care during the fourth stage of labor.

Discuss normal postpartum and

apply the nursing process to facilitate need fulfillment.

Describe the anatomic and physiologic changes that occur during the postpartum period.

Explain characteristics of uterine involution and lochial flow and describe ways to measure them.IV. Postpartum FamilyC. Fourth Stage of Labor

1. Assessments

2. Medical management

3. Nursing careD. Postpartum A&P

1. Uterus

2. Lochia

3. Breast

4. Other

Ch 19 Read

pp472-475

p. 474 Box 19-9 Assessment during the fourth stage of laborCh. 20 Read

pp. 478-485 p. 479, Fig 20-1, Assessment of involution of uterus after childbirth

p. 480, Table 20-1, Lochial and nonlochial bleeding

Clinical Reasoning p 480

Study

p. 483, Table 20-2, Vital Signs after Childbirth

Ch. 21 Read

pp. 486-506

p. 488, Table 21-1, Recovery Nurses Report

p. 488, Box 21-1, Criteria for Early Discharge

p.489, Table 21-2, Postpartum Assessment and Signs of Potential Complications

p. 491, Care Plan: Postpartum Care-Vaginal Birth

p. 492, Box 21-2, Interventions for Episiotomy, Lacerations and Hemorrhoids

p. 493, Fig 21-2, Blood loss after birth

p. 496 Safety alert pp. 498 & 499 Nursing alerts (2)

p. 499 Legal tip

p. 503 Cultural considerations

p. 503 Nursing alert

p 504 Teaching for Self-Management & Clinical reasoning

Study

p 493, Nursing alerts (2 of them) p. 494, Emergency Box: Hypovolemic Shock

p. 494, Fig. 21-3 Palpating fundus

p. 500, Medication Guide RhoGam

p. 500, Signs of Potential Complications: Postpartum Psychosocial Concerns

Scan

p 490 Nursing process p. 497, Fig 21-4 PP exercise

2/24Differentiate normal and abnormal assessment findings during the postpartum period. Identify probably causes for deviations from normal.

Prioritize care for the postpartum patient and family.

Evaluate a patient/family for early postpartum discharge.

Compare and contrast postpartum care for a woman who delivered vaginally and one who delivered by Cesarean.

Develop nursing care plans for a postpartum woman:

Who delivered vaginally, w/o an episiotomy

Who delivered vaginally, w/ an episiotomy

Who delivered by cesarean section w/ epidural/intrathecal analgesia

Who delivered by cesarean section w/ systemic analgesia

Differentiate baby blues and postpartum depression.

Identify community resources available to postpartum families.

Develop a discharge teaching plan for a vaginal and cesarean birth patient.

Provide and evaluate discharge teaching to postpartum families.

Explain the influence of culture on postpartum adjustment.

E. Complications

1. Risk factors

2. Medical management/Nursing Care

F. Nursing Care

1. Assessment

2. Plan/intervene

a. Community resourcesb. Discharge teaching for health promotion

c. Evaluation of care

2/24Describe the integration of the newborn into the family.

Identify parental and infant behaviors that facilitate and those that inhibit parent-infant attachment.

Provide nursing interventions to facilitate parent-infant attachment.

Examine the effect of the following on the transition to parenthood: age, parity, socioeconomic conditions, social support, culture, personal aspirations and sensory impairment.

Compare and contrast maternal and paternal adjustment to parenthood.

Analyze the process of becoming a mother. Identify major nursing theorists of this concept.

Develop a plan to facilitate parent-infant attachment when one or both parents are separated from the newborn.

Provide parent teaching to facilitate sibling attachment.

Describe grandparent adaptation to a new family member.

IV. Psycho-Social Aspectsj(Mother-Baby)

1. Attachment

2. Maternal Role Attainment

3. Adaptation to parenthood

4. Sibling adjustment

5. Grandparents

6. Ch. 22

Read

pp. 507-527

p. 508, Tables 22-1 & 22-2; Infant behaviors affecting parental attachment & Parental behaviors affecting infant attachment.

P. 513 Nursing care plan

P. 515 Coping with postpartum blues

P. 516, table 22-5; early development of the involved father role

P 525, box 22-4 Strategies for facilitating sibling acceptance of a new baby

Study

P. 509, table 22-3, Examples of parent-infant attachment interventions.

p. 510, box 22-1, Assessing attachment behaviors

p. 22-4 Phases of maternal postpartum adjustment

DVD:

Nursing Assessment of the New Family, Disc 3, Nursing Assessment of the Postpartum patient. WY 157.3 N974 2003. On reserve in LRC

On-Line Mosby OB Video Skills Series: Located on the LRC website.Evolve HESI Case Studies: Obstetric/Maternity: Postpartum. THIS IS A QUIZ GRADE Due 10/28 by 0800.

UNIT IV: NEWBORN

3/3Explain the physiologic adaptations that the neonate must make during the period of transition from the intrauterine to the extra uterine environment.

Compare and contrast the first and second period of reactivity.

Describe the behavioral adaptations that are characteristic of the newborn during the transition period.

Explain the mechanisms of thermoregulation in the neonate and the potential consequences of hypothermia and hyperthermia.

Differentiate neonatal heat loss via conduction, radiation, convection and evaporation.

Distinguish stool patterns of neonates.

Differentiate caput succedaneum and cephalhematoma.

Recognize newborn reflexes and differentiate normal and abnormal responses.

Discuss the sensory and perceptual functioning of the neonate.

III. NewbornB. Neonatal Period Intro

C. Transition

D. Physiologic Adaptations to extra uterine life

1. Respiratory

2. CV

3. Hematopoietic

4. Thermoregulatory

5. Hepatic

6. Integumentary

7. Reproductive

8. Skeletal

9. Neuromuscular

E. Behavioral Characteristics

Ch 19

Read

p. 467, Immediate Assessments and care of the newborn

Ch. 23

Read

pp.528-552


p. 530, Table 23-1, Characteristics of the Respiratory System of the Neonate

p. 531, Table 23-2, Cardiovascular Changes at Birth

p. 534, Nursing alert

Fig 23-3, p 537, Formation and excretion of bilirubin

p. 538, Table 23-3 Causes of Un- conjugated (Indirect) hyperbilirubinemia

p. 545, Box 23-2, Clusters of Neonatal Behaviors in the Brazelton Neonatal Behavioral Assessment Scale

pp. 546-549, Table 23-4, Assessment of Newborn Reflexes

p. 549, Fig. 23-12 A-F summary of newborn sleep-wake states

Study

Fig. 23-2, p. 534. Effects of cold stress

p. 536, Box 23-1 Changes in Stooling Patterns of Newborns


p. 542, Fig. 23-8 A&B

p. 543 Fig. 23-9 A, B, C

Scan

p. 540, Fig., 23-4; p. 541, Fig. 23-5 A&B; p. 542, Fig. 23-6 A&B, 23-7

p. 544 Figs 23-10 & 23-11 A-D

Exercise/Quiz 3:HESI case study: Postpartum

3/17Explain the purpose of the Apgar score.

Assign Apgar score to neonate.

Provide nursing interventions to a newborn based on Apgar score.

Prioritize immediate care of the neonate at birth.

Explain neonatal resuscitation protocol.

Analyze pharmaceuticals used during the transition period, including drug classification, route(s) of administration, therapeutic effects, side effects and contraindications.

Promote attachment of the new family to the neonate at birth.F. Nursing Care

1. Initial Care at birth

a. Risk Assessment/Birth Preparations

b. Apgars/ care based on Apgars

c. Neonatal Resuscitation

d. Thermoregulation

e. General Assessment

f. Medications

i. NRP meds

ii. Antibiotics

iii. Opthalmic ointment

iv. Vit. K

g. Identification procedures

h. Attachment facilitationCh. 24

Read

pp 553-591(to discharge planning

p. 554, Box 24-1, Assessment of Preconception, Prenatal, and Intrapartum Risk Factors

p. 554, Box 24-2, Initial Physical Assessment of the Newborn

p. 555, Box 24-3, Significance of the Apgar Score

p. 555, Box 24-4, Performing a Physical Examination of the Newborn

p. 566 Nursing Care plan

pp. 567-568, Fig 24-1, Estimation of gestational age

p. 568, Box 24-5 Maneuvers used

p. 569 Nursing Process

p. 570, Procedure: Suctioning with a Bulb Syringe


p. 578, Table 24-3, Newborn screening

p. 581, Fig. 24-12 A-D, Swaddling

p. 590, Table 24-4

Study

pp 556-565; Table 24-2, Physical Assessment of the Newborn

p. 570, Signs of potential complications

p. 572-573, Medication Guides (eye prophylaxis; Vit. K)


p. 577 Box 24-6, Standard Lab. . .

p. 580, Fig 24-10 Heelstick

p. 583 Medication Guide (Hep B vaccine)

p. 584 Medication Guide (Hep B IG)

p. 584, Fig 24-16 A&B (IM injection)

p. 588, Box 24-7, Care of the circumcised

Memorize

p. 554, Table 24-1, Apgar Score

Scan

EBP p. 571

P. 576, Fig. 24-8

DVD: On computers in LRC. (Interactive Discs are also available on reserve if you want to do an interactive format)

Nursing Assessment of the New Family, Disc 1: Physical Assessment of the Newborn and Disc 2, Gestational age Assessment of the Newborn WY157.3 N974 2003

EVOLVE ON-LINE VIDEO: Head to toe assessment of the

Supplemental Reading: Handouts on Blackboard:

Circumcision

Newborn Pharmacology

3/17Describe danger signals or signs in the neonate that indicate actual or potential problems.

Apply the nursing process to facilitate need fulfillment of the normal newborn.

Differentiate normal and abnormal physical (incl. VS) and gestational age assessments of the newborn

Recognize common variations of normal assessment findings in the newborn.

Provide parent education on behavioral states in the newborn.

Identify neonatal cold stress and provide appropriate nursing interventions.

Assess for pain signals in the newborn.

Appropriately manage neonatal pain.

Debate the risks and benefits of circumcision.

Compare and contrast methods of circumcision.

Provide postoperative care of the circumcised patient.

Provide parent teaching for circumcision care.

Explain the indications for use, therapeutic effects, side effects, dosage, route of administration, contraindications and nursing implications of medications administered during the neonatal period.

Describe procedures for doing a heel stick, collecting urine specimens, assisting with venipuncture and restraining the newborn.

Provide nursing interventions to promote neonatal thermoregulation.

Maintain a safe environment for the neonatal patient.

Develop appropriate parent teaching discharge plans.

Describe newborn screening tests and discuss their importance in preparation for discharge.2. Ongoing Care

a. Assessmentsi. Risk identification

ii. Physical

iii. Gestational age assessment

iv. Assessment of behavioral states

v. Assessment of pain

b. Interventions and Procedures

i. Circumcisions

ii. Tx of jaundice/Phototherapy

iii. Newborn screening

iv. Medication

v. Pain management

vi. Thermoregulation

c. Safe environmentd. Complications

Exercise/Quiz 4: HESI case study: Healthy Newborn

3/24Provide anticipatory guidance for the new family at home.

Evaluate neonate for early discharge.

3. Care of the Newborn at Home/ Parent discharge teachingCh 24

Read

pp. 591-604; Discharge Planning and Teaching Section

p. 588, Box 24-7, Care of the Circumcised Neonate at Home pp. 596-597, Box 24-9, Bathing, Cord Care, Skin Care, and Nail Care p. 598, Box 24-10, Newborn Progress after Early Discharge p. 604, Box 24-14, Signs of Illness

Supplemental Reading: Handout on Blackboard

Newborn

Postpartum care and Parent Teaching

3/246/25Explain the nutritional requirements of the newborn.

Provide supportive guidance to the family choosing an infant feeding method.

Provide patient/family teaching on the benefits of breastfeeding.

Recognize newborn feeding-readiness cues.

Describe the anatomy and physiology of breastfeeding.

Provide nursing interventions to facilitate and promote successful breastfeeding.

Analyze common problems associated with breastfeeding and nursing interventions to help resolve them.

Evaluate maternal and neonatal indicators of effective breastfeeding.

Compare and contrast powdered, concentrated and ready-to-use forms of commercial infant formula.

Calculate recommended amount of formula per feeding for a newborn (based on wt).

Provide parent teaching for bottle and breast feeding families.

G. Newborn nutrition and feeding

1. infant development & nutritional requirements/research findings

2. assessment of responses

3. medical management

4. nursing diagnoses, goals,

5. interventions

6. evaluation of care

Ch. 25

Read

pp 606-634

p. 608, Table 25-1, Benefits of Breastfeeding

p. 609, Box 25-1, Ten steps to Successful Breastfeeding for Hospitals

p. 612, Fig 25-2 Anatomy of the lactating breast

p. 612, Fig 25-3, Enhanced view of milk glands and milk ducts

p. 612, Fig 25-4, Maternal breastfeeding reflexes

p. 615, Fig 25-5, Breastfeeding positions

p. 616, Fig 25-6, Latch

Study

p. 617, Box 25-2, Signs of Effective Breastfeeding

p. 618 Nursing Care Plan: Breastfeeding and Infant Nutrition

p. 620, Box 25-5, Warning Signs of Ineffective Breastfeeding

p. 624, Breast Milk Storage Guidelines for Home Use for Full Term Infants

p. 633, Teaching for Self-Care: Formula Preparation and feeding

Supplemental Reading: Handouts on Blackboard:

Infant Feeding and Parent Instructions

AAP Statement 2005

Back to Work TDH

Breastfeeding fact sheets

Breastfeeding twins

Colostrum

Instructional Guide for Breast Feeding Your Baby

Unit V Special needs

3/31Discuss complications of childbearing and apply the nursing process to facilitate need fulfillment.

Differentiate among risks factors, etiologies, signs and symptoms, possible complications, disease transmission and medical and nursing management for TORCH infections.Provide patient teaching regarding toxoplasmosis in pregnancyDiscuss the effect of group B streptococcus (GBS) on pregnancy and management of pregnant women and their fetuses/neonates with GBS.

Compare and contrast signs, symptoms, and management of nonpregnant and pregnant women with sexually transmitted infections (include HIV and Hepatitis)

Provide patient counseling for HIV testing during pregnancy.

Develop a patient teaching care plan for a woman with a sexually transmitted infection during pregnancy.

Identify the most common bacterial sexually transmitted infection.Identify risks factors, signs and symptoms, possible complications and medical and nursing management of neonatal group B streptococcus (GBS) infection in the neonate.Explain transmission routes of HIV from mother to fetus/neonate.Evaluate risk factors, signs and symptoms, possible complications and medical and nursing management of HIVIdentify the most important nursing action to prevent neonatal infection.

V. Special Needs: Care of Women and FamiliesA. Infections

1. TORCH

2. Bacterial infections in pregnancy/neonate (Chlamydia, Gonorrhea, Syphilis, Group B Strep)

3. Perinatal viral infections - HIV, Hepatitis

4. Neonatal infections (TORCH, HIV, sepsis, etc.)

This unit has been introduced through out the course and now we will cover specific conditions.

Ch. 7

Scan

Pp.143-168 focus on effects of infection during pregnancy & birth as outlined in objectives, this is not new material

Read

p. 162, Table 7-6, Pregnancy and Fetal Effects of Common Sexually Transmitted Infections

p. 163; Table 7-7, TORCH Infection: Maternal and Fetal

Ch 35

Read

pp 844-856

p. 854, Fig. 35-10, Newborn Infection Management algorithm

Study

p. 844, Table 35-2, Risk Factors for Neonatal Sepsis p. 847, Table 35-3, Signs of Sepsis p. 848, Box 35-1, TORCH Infections Affecting Newborns

Supplemental Reading: Handout on Blackboard:

Complications

3/31Differentiate the signs and symptoms, medical and nursing management of incomplete, inevitable, septic and threatened spontaneous abortions and ectopic pregnancies

Compare and contrast abruptio placenta and placenta previa in relation to risk factors, signs and symptoms, complications and management.

Explain nursing management of vaginal bleeding of unknown origin during pregnancy.

Review the physiology and symptoms of a hydatidiform mole (gestational trophoblastic disease) and the risk for the womans immediate health future.

Describe causes, signs and symptoms and medical and nursing management of postpartum hemorrhage.

Describe risk factors, signs and symptoms and medical and nursing management of postpartum perineal hematomas.

Explain the indications for use, therapeutic effects, side effects, contraindications and nursing implications of medications administered to treat hemorrhagic conditions during the perinatal period.

Describe causes, signs and symptoms and medical and nursing management of thromboembolic disorders during the post partum period.

B. Hemorrhagic Disorders

1. AntepartumAbortions/Miscarriages, ectopics, placental abruption/previa; molar pregnancy2. Postpartum Hemorrhage

3. Clotting Disorders

Ch 28

Read

p. 671, Fig 28-1, Types of miscarriages p. 672, Table 28-1, Assessing Miscarriage and the Usual Management p. 675, Teaching for Self-Care: Discharge Teaching for the Woman after Early Miscarriage

p. 678, Box 28-1, Nursing Considerations for Clients Undergoing Methotrexate Treatment of Ectopic Pregnancy

p 680 Nursing alert

p. 681, Table 28-2, Summary of Findings: Abruptio Placentae and Placenta Previa

p. 682 Nursing Process

p. 684, Fig 28-10 Abruptio placentae

p. 686, Box 28-2, Clinical Manifestations and Laboratory Screening Results for Women with DIC

Scan

P. 676 Figs 28-2 & 28-3

P. 679 Figs 28-5, 28-6 & 28-7

P. 686, Figs 28-11 & 28-12

Ch 34

Read

pp 824-833 (PPH ,Coagulopathies, Thromboembolic disease)

p. 826, Nursing alert

p. 830: Nursing Care Plan, Postpartum Hemorrhage

p. 828, Fig. 34-1, Nursing Assessments for postpartum Bleeding

p 829 Nursing alert

Study

p. 825, Box 34-1, Risk Factors and Causes of Postpartum Hemorrhage p. 827, Medication Guide: Drugs Used to Manage Postpartum Hemorrhage.

3/31Identify risk factors for preterm labor.

Explain the defining characteristics of preterm labor.

Provide patient teaching regarding reportable symptoms of preterm labor, preterm rupture of the membranes.

Recognize symptoms of preterm labor and provide nursing interventions.

Analyze the use of tocolytics and antenatal glucocorticoids in preterm labor and birth.

Recognize the risk factors, signs and symptoms of chorioamnionitis

Provide nursing care for a woman with preterm premature rupture of the membranes.

Explain the care of a woman with post term pregnancy

Describe immediate nursing care for a patient experiencing: prolapsed umbilical cord, shoulder dystociaC. Labor and Birth Complications

1. Preterm labor and birth (PTL)

2. Preterm Premature rupture of membranes (PPROM)

3. Post term labor and birth

4. Obstetric emergencies

a. shoulder dystocia

b. prolapsed cord

c. ruptured uterus

d. amniotic fluid embolism

Ch 33

Read

pp. 779-792; 815-821

p. 780, Box 33-1, Risk Factors for Preterm Labor & Box 33-2, Common Causes of Indicated Preterm Birth p.782, Nursing Care Plan: Preterm Labor

p. 784, Box 33-4, Adverse Effects of Bedrest

p. 786, Box 33-5, Contraindications to Tocolysis and Box 33-6, Nursing Care for Women receiving Tocolytic Therapy

Teaching of self-management, p. 791

Teaching for Self-Management: Post-term Pregnancy p.816

Emergency: Immediate Management of Newborn with Meconium-Stained Fluid p. 817


Fig 33-15 Application of Suprapubic pressure & Fig 33-16 McRobers maneuver p. 818

Emergency Box: Anaphylactoid Syndrome of Pregnancy p. 820 Study

p. 783, Box 33-3, Signs and Symptoms of Preterm Labor & Teaching for Self- Management, What to Do If Symptoms of Preterm Labor Occur

p. 786 Safety alert

pp. 787-790, Medication Guides: Tocolytic Therapy for Preterm Labor & Betamethasone

Fig 33-17& 33-18 Prolapse Cord/Interventions p. 819

Emergency Box: Prolapsed Umbilical Cord p. 819

3/31Differentiate the causes of postpartum infection.

Summarize the assessment and care of the woman with a post partum infection.

Recognize therapeutic effects and side effects of pharmaceuticals used to treat complications of pregnancy, labor and birth.

Discuss psychosocial adaptation

of a family when the mother has a

high-risk pregnancy.

Identify postpartum emotional complications, including incidence, risk factors, signs and symptoms, and management.

Evaluate the role of the nurse in assessing and managing care of women with emotional complications during pregnancy and postpartum.

D. Postpartum infections

1. Endometritis

2. Wound infections

3. Urinary Tract Infections

4. Mastitis

E. Post Partum Depression

Ch 34

Read

pp 833-835 p. 834, Box 34-4, Predisposing Factors for Postpartum Infection

Ch. 32

Read

pp. 767-776

p. 771, Nursing Care Plan: Postpartum Depression (PPD)

p. 771, Teaching for Self-Care: Activities to Prevent Postpartum Depression


Study

p. 768, Box 32-3, Risk Factors for Postpartum Depression

4/7EXAM 2

4/7Differentiate the defining characteristics of gestational hypertension, preeclampsia/ eclampsia and chronic hypertension in pregnancy.

Assess an obstetric patient for symptoms of pre eclampsia.

Provide patient teaching regarding reportable symptoms of preeclampsia.

Develop a plan of care for a woman with pre eclampsia.

Explain the indications for use, therapeutic effects, side effects, contraindications and nursing implications of medications used to treat hypertension in pregnancy.

Identify and prioritize nursing care for magnesium toxicity.

Prioritize nursing management of eclamptic seizures.

Interpret laboratory finding related to:

Pre-eclampsia/HELLP/DIC

F. Hypertensive disorders

1. Classifications

2. Pre eclampsia / Eclampsia / HELLP

3. Pathophysiology4. Medical Management5. Nursing Care6. Chronic hypertension management in pregnancy

Ch. 27

Read

pp. 654 669

p. 656, Table 27-3, Common Laboratory Changes in Preeclampsia

pp. 662-663, Teaching for Self Care:

Assessing and Reporting Clinical Signs of Preeclampsia

Coping with Activity Restriction

Diet for Preeclampsia

p. 664: Nursing Care Plan: Severe Preeclampsia

p. 665, Box 27-3, Care of Women with Preeclampsia Receiving Magnesium Sulfate

p 665 Nursing alerts (2 of them)

p. 666, Table 27-5, Pharmacologic Control of Hypertension in Pregnancy

p. 667, Emergency, Eclampsia

Study

p. 655, Table 27-1, Classification of Hypertensive States of Pregnancy & Table 27-2: Differentiation Between Mild and Severe Preeclampsia p. 657, Box 27-1, Risk Factors for Preeclampsia p. 657, Fig 27-1 Etiology of preeclampsia & Fig 27-2, Consequences of endothelial cell dysfunction

p. 664, Box 27-2, Hospital Precautionary Measures

11/18Differentiate gestational and pregestational diabetes mellitus.

Discuss the effects of pregnancy on diabetes and of diabetes on pregnancy outcomes.

Explain medical management of diabetes in pregnancy.

Compare insulin requirements throughout the trimesters of pregnancy, postpartum and with lactation.

Interpret laboratory finding related to:

Diabetes in pregnancy

Develop a plan of care for the pregnant woman with pregestational or gestational diabetes.

Discuss the management of the woman with hyperemesis gravidarum.

Identify complications associated w/ maternal Phenylketonuria in pregnancy.G. Endocrine & Metabolic Disorders

1. Diabetes

a. Classifications

i. Gestational / Pre-gestational

ii. Classification of Diabetes in Pregnancy

b. Pathogenesis

c. Care management

2. Hyperemesis Gravidarum

3. Maternal PKU

Ch 29

Read

pp. 688 708

p. 690, Table 29-1 Whites Classification of Diabetes in Pregnancy (Modified)

p. 690, Fig. 29-1, Changing insulin needs during pregnancy

p. 703: Nursing Care Plan, The Pregnant Woman with Gestational Diabetes

Study

p. 695, Table 29-3, Target Blood Glucose levels during Pregnancy

p. 695, Teaching for Self Care: Dietary Management of Diabetic Pregnancy

p. 703, Fig 29-4, Screening and diagnosis for gestational diabetes.

Scan/review

p. 692, Table 29-2, Differentiation of Hypoglycemia (Insulin Shock) and Hyperglycemia (Diabetic Ketoacidosis)

p. 697, Table 29-4, Common Insulin Preparations

Lecture, Class discussion, PowerPoint, Tegrity and Case studies

4/14Apply the nursing process to

facilitate need fulfillment for the

newborn with complications.Prioritize nursing care for a high risk newborn. Analyze the differences in the characteristics of preterm, near-term, post term and post mature neonates.

Identify risk factors for neonatal respiratory distress syndrome.

Discuss respiratory distress syndrome and the approach to treatment.

Explain the indications for use, therapeutic effects, administration guidelines and nursing care of the patient receiving neonatal surfactant.

Differentiate among risks factors, etiologies, signs and symptoms, possible complications and medical and nursing management for RDS and TTNAnalyze the pathophysiology of meconium aspiration syndrome and its clinical signs.

Differentiate among risks factors, signs and symptoms, possible complications and medical and nursing management for the LGA and SGA infantsDifferentiate among risks factors, signs and symptoms, possible complications and medical and nursing management for the infant of a diabetic mother and a low risk infant.Analyze complications of Infant of a Diabetic Mother (IDM) and Large for Gestational Age (LGA) infants.H. Complications of the newborn

1. High Risk Neonates

a. Preterm

b. Complications RDS, IVH, NEC, MAS

c. Near-term

d. Post term

e. SGA/LGA/IDM/birth trauma

Ch. 37

Read

pp 894-928 pp. 900-901: Nursing Care Plan: The High Risk Preterm Newborn p. 918, Box 37-5, Proposed Risk Factors for Necrotizing Enterocolitis

p. 920, Box 37-6, Manifestations of Acute Pain in the Neonate

p. 922, Table 37-3, Late Preterm Infant Assessment and Interventions Study

p. 905, Medication Guide: Surfactant

p. 916, Fig 37-13, Pathogenesis of respiratory distress syndrome

Ch 35

Read

Pp 837- 844

P 845, Nursing Care Plan:,Infant of the mother with pregestational or gestational diabetes.

4/14Compare and contrast symptoms of infants born to drug addicted mothers and infants with fetal alcohol syndrome

Identify the leading cause of preventable mental retardation in the US.

Compare and contrast physiologic and pathologic jaundice.

Develop nursing plans of care for a neonate with physiologic jaundice and for a neonate with pathologic jaundice.

Describe neonatal phototherapy. Provide parent teaching for neonatal phototherapy.

Identify symptoms of hyperbilirubinemia in the neonate.

Differentiate physiologic and pathologic hyperbilirubinemia.

Compare RH and ABO incompatibility.

Explain nursing management to prevent the pathologic consequences of hyperbilirubinemia.

1. Acquired Problems of the Neonate

a. Maternal substance abuse

2. Hemolytic disorders

a. Physiologic Jaundice

b. Pathologic Jaundice

c. Hemolytic disease of the newborn

Ch. 35

Read

pp. 856-864

p. 857, Table 35-4, Summary of Neonatal Effects of Commonly abused Substances & Table 35-5, Signs of Neonatal Abstinence Syndrome

p. 858, Box 35-2, Diagnostic Criteria for Fetal Alcohol Syndrome and Alcohol-Related Effects

p. 860, Box 35-3 Fetal and Neonatal Effects of Maternal Cocaine Use During Pregnancy

p. 863, Nursing Care Plan: The Infant Experiencing Drug Withdrawal (Neonatal Abstinence Syndrome)

p. 863, Box 35-4, Care of the Infant Experiencing Withdrawal(Neonatal Abstinence Syndrome)

Ch. 36

Read

pp 867-873

p 868, Box 36-1Monitoring for Juandice after early discharge p. 869, Box 36-2 Potential causes of pathologic hyperbilirubinemia in neonates

p. 871, bos 36-3, Indications for amount of RHo(D) IG to be administered

p. 872 Nursing care planSupplemental reading on Blackboard:

Hyperbilirubinemia

Exercise/Quiz 5 & 6: HESI case studies: Gestational diagetes; pre eclampsia

4/21Describe the emotional needs of families with a baby who has neonatal complications

Promote parent infant interaction in the NICU.Evaluate the grief process in the family experiencing perinatal loss.Identify specific nursing interventions to meet the special needs of parents and their families related to perinatal loss and grief.

Differentiate among helpful and nonhelpful responses in caring for parents experiencing loss and grief.

Discuss the personal and societal issues that may complicate responses to perinatal loss.I. Perinatal grief and loss

a. Grief responses

b. Family aspects

c. Nursing interventionsCh. 38

Read

pp. 931-948

p. 933, Box 38-1, Conceptual Model of Parental Grief p. 942, Box 38-2, What to Say and What Not to Say to Bereaved Parents p. 947, Nursing Care Plan: Fetal Death at 24 weeks

DVD: To Lose a Child to be shown in class

4/28HESI

TBAFINAL EXAM

Scan/review look at pages, identify key words, paragraph headings & subheadings, tables, boxes, diagrams, etc. Read any info that it unfamiliar to you.

Read read the information for general understanding; USUALLY is a supplement to lectures, make sure you understand the material covered.

Study important information. Usually a box, table or diagram that summarizes much of the content of the reading. This should help you recall what you read.

Memorize I use this term only rarely. This is critical, factual information that you MUST know.

33

Documents

Lesson Plan Spring 14